Vitamin B12 deficiency causes: Difference between revisions

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{{Vitamin B12 deficiency}}
{{Vitamin B12 deficiency}}
{{CMG}}
{{CMG}} {{AE}} {{LRO}}
 
==Overview==
Common causes of vitamin B12 deficiency include insufficient dietary intake, as well as diseases and [[iatrogenic]] procedures causing problems in absorption. It is common in individuals adhering to [[vegetarian]] or [[vegan]] diets without external supplementation, due to primary sources including animal products such as meat, eggs, and dairy.


==Causes==
==Causes==
* Inadequate dietary intake of vitamin B<sub>12</sub>. As the vitamin B<sub>12</sub> occurs naturally only in animal products (eggs, meat, milk) a [[vegan]] diet can produce a deficiency unless one uses supplements or eats enriched food.<ref>[http://www.pernicious-anaemia-society.org/whatispa.html Pernicious Anaemia Society - What is Pernicious Anaemia?], retrieved July 30, 2007.</ref>  
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===Common Causes===
* Selective impaired absorption of vitamin B<sub>12</sub> due to [[intrinsic factor]] deficiency. This may depend on loss of [[stomach|gastric]] [[parietal cells]] in chronic [[atrophic gastritis]] (in which case, the resulting [[megaloblastic anaemia]] takes the name of "[[pernicious anaemia]]"), or on wide surgical resection of stomach (such as in [[bariatric surgery]]), or on rare hereditary causes of impaired synthesis of intrinsic factor. It takes years to develop deficiency after dietary absorption stops.
*Insufficient diet
 
*[[Malabsorption syndrome]]
* Impaired absorption of vitamin B<sub>12</sub> in the setting of a more generalized [[malabsorption]] or maldigestion syndrome. This includes any form of structural damage or wide surgical resection of the terminal [[ileum]] (the principal site of vitamin B<sub>12</sub> absorption), forms of [[achlorhydria]] (including that artificially induced by drugs such as [[proton pump inhibitors]]), as well as [[bacterial overgrowth]] (such as in [[blind loop syndrome]]).
*[[Gastrectomy]] <ref name="pmid28457771">{{cite journal |vauthors=Camarero-Shelly M, Pellitero S, Martínez E, Puig R, Leis A, Zavala R, Granada ML, Pastor C, Moreno P, Tarascó J, Balibrea J, Puig-Domingo M |title=[Vitamin B12 levels in the patient population attending an urban health centre in Madrid] |language=Spanish; Castilian |journal=Semergen |volume=44 |issue=3 |pages=161–167 |date=April 2018 |pmid=28457771 |doi=10.1016/j.semerg.2017.03.006 |url=}}</ref>
 
*[[Gastritis]]
* Chronic intestinal infestation by the [[fish tapeworm]] ''[[Diphyllobothrium]]'', that competes for vitamin B<sub>12</sub>, seizing it for its own use and therefore leaving insufficient amount for the host organism. This is mostly confined to Scandinavia and parts of Eastern Europe (for example, in preparers of gefilte fish, who would acquire the tapeworm by sneaking bits of uncooked fish while making the Eastern European delicacy, now eaten by Jews at Pesach).
*[[Ileal resection]]
 
*[[Postgastrectomy syndrome]]
* The [[diabetes]] medication, [[metformin]], may interfere with B12 dietary absorption.<ref>{{cite journal | author = Ting R, Szeto C, Chan M, Ma K, Chow K | title = Risk factors of vitamin B(12) deficiency in patients receiving metformin | journal = Arch Intern Med | volume = 166 | issue = 18 | pages = 1975-9 | year = 2006 | id = PMID 17030830}}</ref>.
*[[Crohn's disease]] <ref name="pmid28335526">{{cite journal |vauthors=Gomollón F, Gargallo CJ, Muñoz JF, Vicente R, Lue A, Mir A, García-Alvarado M, Gracia M, García-López S |title=Oral Cyanocobalamin is Effective in the Treatment of Vitamin B12 Deficiency in Crohn's Disease |journal=Nutrients |volume=9 |issue=3 |pages= |date=March 2017 |pmid=28335526 |pmc=5372971 |doi=10.3390/nu9030308 |url=}}</ref>
 
*[[Celiac disease]] <ref name="pmid5323299">{{cite journal |vauthors=Orskov I, Orskov F |title=Episome-carried surface antigen K88 of Escherichia coli. I. Transmission of the determinant of the K88 antigen and influence on the transfer of chromosomal markers |journal=J. Bacteriol. |volume=91 |issue=1 |pages=69–75 |date=January 1966 |pmid=5323299 |doi= |url=}}</ref>
* Hereditary causes such as severe [[MTHFR]] deficiency, [[homocystinuria]], and [[transcobalamin]] deficiency.
*[[Bariatric surgery]]
 
*[[Idiopathic]]
====Drug Side Effect====
*[[Bacterial]] infection
*long term Metformin use <ref name="pmid20488910">{{cite journal |vauthors=de Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD |title=Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial |journal=BMJ |volume=340 |issue= |pages=c2181 |date=May 2010 |pmid=20488910 |pmc=2874129 |doi= |url=}}</ref>


* [[Metformin]], [[Glyburide and Metformin]]
===Causes by Organ System===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
|-
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
| bgcolor="Beige" | [[Nitroux oxide abuse]]
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" | [[Cimetidine]], [[Glyburide ]] ,  [[Metformin hydrochloride]],  [[Neomycin]],  [[Omeprazole]],  [[Pantoprazole]],  [[Prolonged antiacid use]],  [[Rabeprazole]],  [[Ranitidine hydrochloride]],  [[Saxagliptin hydrochloride ]]
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" | [[Graves' disease]]
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" | [[Achlorhydria]],  [[Atrophic gastritis]],  [[Bariatric surgery]],  [[Blind loop syndrome]],  [[Bothriocephalosis]],  [[Celiac disease]],  [[Chronic pancreatitis]],  [[Cobalamin malabsorption]],  [[Crohn's disease]],  [[Gastrectomy]],  [[Gastritis]],  [[Grasbeck-imerslund disease]],  [[Ileal resection]],  [[Imerslund-najman-grasbeck anemia]],  [[Malabsorption syndrome]],  [[Pancreatic insufficiency]],  [[Pancreatitis]],  [[Postgastrectomy syndrome]],  [[Small bowel disease]]
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" | [[Homocystinuria]],  [[Mthfr deficiency]]
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" | [[Grasbeck-imerslund disease]],  [[Imerslund-najman-grasbeck anemia]],  [[Intrinsic factor deficiency ]] ,  [[Juvenile megaloblastic anemia]],  [[Macrocytic anemia]],  [[Megaloblastic anemia]],  [[Pernicious anemia]],  [[Transcobalamin deficiency]]
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" | [[Bariatric surgery]],  [[Gastrectomy]],  [[Ileal resection]],  [[N2o anesthesia ]] ,  [[Postgastrectomy syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" | [[Bothriocephalosis]],  [[Diphyllobothrium latum]]
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| bgcolor="Beige" | [[Cobalamin malabsorption]],  [[Excessive alcohol consumption]],  [[Insufficient diet]],  [[Veganism]],  [[Vegetarianism]]
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| bgcolor="Beige" | [[Excessive alcohol consumption]],  [[Nitroux oxide abuse]]
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" | [[Crohn's disease]],  [[Systemic lupus erythematosus]]
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" | [[Idiopathic]]
|-
|}


===Cause in Alphabetical Order===
{{columns-list|
*[[Achlorhydria]]
*[[Atrophic gastritis]]
*[[Bariatric surgery]]
*[[Blind loop syndrome]]
*[[Bothriocephalosis]]
*[[Celiac disease]]
*[[Chronic pancreatitis]]
*[[Cimetidine]]
*[[Cobalamin malabsorption]]
*[[Crohn's disease]]
*[[Diphyllobothrium latum]]
*[[Excessive alcohol consumption]]
*[[Gastrectomy]]
*[[Gastritis]]
*[[Glyburide ]]
*[[Grasbeck-imerslund disease]]
*[[Graves' disease]]
*[[Homocystinuria]]
*[[Idiopathic]]
*[[Ileal resection]]
*[[Imerslund-najman-grasbeck anemia]]
*[[Insufficient diet]]
*[[Intrinsic factor deficiency ]]
*[[Juvenile megaloblastic anemia]]
*[[Macrocytic anemia]]
*[[Malabsorption syndrome]]
*[[Megaloblastic anemia]]
*[[Metformin hydrochloride]]
*[[Mthfr deficiency]]
*[[N2o anesthesia ]]
*[[Neomycin]]
*[[Nitroux oxide abuse]]
*[[Omeprazole]]
*[[Pancreatic insufficiency]]
*[[Pancreatitis]]
*[[Pantoprazole]]
*[[Pernicious anemia]]
*[[Postgastrectomy syndrome]]
*[[Prolonged antiacid use]]
*[[Rabeprazole]]
*[[Ranitidine hydrochloride]]
*[[Saxagliptin hydrochloride ]]
*[[Small bowel disease]]
*[[Systemic lupus erythematosus]]
*[[Transcobalamin deficiency]]
*[[Veganism]]
*[[Vegetarianism]]
}}
</div>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Autoimmune diseases]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Primary care]]
{{WH}}
{{WS}}

Latest revision as of 00:41, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

Common causes of vitamin B12 deficiency include insufficient dietary intake, as well as diseases and iatrogenic procedures causing problems in absorption. It is common in individuals adhering to vegetarian or vegan diets without external supplementation, due to primary sources including animal products such as meat, eggs, and dairy.

Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning Nitroux oxide abuse
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cimetidine, Glyburide , Metformin hydrochloride, Neomycin, Omeprazole, Pantoprazole, Prolonged antiacid use, Rabeprazole, Ranitidine hydrochloride, Saxagliptin hydrochloride
Ear Nose Throat No underlying causes
Endocrine Graves' disease
Environmental No underlying causes
Gastroenterologic Achlorhydria, Atrophic gastritis, Bariatric surgery, Blind loop syndrome, Bothriocephalosis, Celiac disease, Chronic pancreatitis, Cobalamin malabsorption, Crohn's disease, Gastrectomy, Gastritis, Grasbeck-imerslund disease, Ileal resection, Imerslund-najman-grasbeck anemia, Malabsorption syndrome, Pancreatic insufficiency, Pancreatitis, Postgastrectomy syndrome, Small bowel disease
Genetic Homocystinuria, Mthfr deficiency
Hematologic Grasbeck-imerslund disease, Imerslund-najman-grasbeck anemia, Intrinsic factor deficiency , Juvenile megaloblastic anemia, Macrocytic anemia, Megaloblastic anemia, Pernicious anemia, Transcobalamin deficiency
Iatrogenic Bariatric surgery, Gastrectomy, Ileal resection, N2o anesthesia , Postgastrectomy syndrome
Infectious Disease Bothriocephalosis, Diphyllobothrium latum
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Cobalamin malabsorption, Excessive alcohol consumption, Insufficient diet, Veganism, Vegetarianism
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity Excessive alcohol consumption, Nitroux oxide abuse
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Crohn's disease, Systemic lupus erythematosus
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Idiopathic

Cause in Alphabetical Order

References

  1. ↑ Camarero-Shelly M, Pellitero S, Martínez E, Puig R, Leis A, Zavala R, Granada ML, Pastor C, Moreno P, Tarascó J, Balibrea J, Puig-Domingo M (April 2018). "[Vitamin B12 levels in the patient population attending an urban health centre in Madrid]". Semergen (in Spanish; Castilian). 44 (3): 161–167. doi:10.1016/j.semerg.2017.03.006. PMID 28457771.
  2. ↑ Gomollón F, Gargallo CJ, Muñoz JF, Vicente R, Lue A, Mir A, García-Alvarado M, Gracia M, García-López S (March 2017). "Oral Cyanocobalamin is Effective in the Treatment of Vitamin B12 Deficiency in Crohn's Disease". Nutrients. 9 (3). doi:10.3390/nu9030308. PMC 5372971. PMID 28335526.
  3. ↑ Orskov I, Orskov F (January 1966). "Episome-carried surface antigen K88 of Escherichia coli. I. Transmission of the determinant of the K88 antigen and influence on the transfer of chromosomal markers". J. Bacteriol. 91 (1): 69–75. PMID 5323299.
  4. ↑ de Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD (May 2010). "Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial". BMJ. 340: c2181. PMC 2874129. PMID 20488910.

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